1639346372 NPI number — MRS. JESSICA BROOKE CLIFF MFT

Table of content: MRS. JESSICA BROOKE CLIFF MFT (NPI 1639346372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639346372 NPI number — MRS. JESSICA BROOKE CLIFF MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLIFF
Provider First Name:
JESSICA
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SARTAIN
Provider Other First Name:
JESSICA
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639346372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 OLD CROW CANYON RD
Provider Second Line Business Mailing Address:
SUITE 218
Provider Business Mailing Address City Name:
SAN RAMON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94583-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-328-0186
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 OLD CROW CANYON RD
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
SAN RAMON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94583-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-328-0186
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 45576 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)